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Endovascular therapy for upper-extremity PAD with critical hand ischemia successful, but prognosis poor
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In a subanalysis of the SCALLOP registry, endovascular therapy for upper-extremity peripheral artery disease with critical hand ischemia was associated with an initial success rate of 87% and alleviation of symptoms in the majority of cases.
Researchers in Japan analyzed data on 36 consecutive patients who underwent endovascular therapy for de novo upper-limb PAD with critical hand ischemia in 40 limbs at Japanese CV centers from January 2003 to December 2013. The mean age of the cohort was 66 years, 19 patients were men, half had diabetes and two-thirds were on dialysis.
Mean follow-up for this subanalysis was 27 months.
Initial success of endovascular therapy, defined as straight-line flow to the hand and residual diameter stenosis of 50% or less for balloon angioplasty alone and 30% or less without flow-limiting dissection for subclavian artery stenting, was achieved in 87% of cases, according to the results published in the Journal of Endovascular Therapy. Puncture-site problems occurred in one patient. Three patients (four treated limbs) died within 30 days after endovascular therapy.
Overall, hand symptoms were alleviated in 92% of limbs that underwent endovascular therapy.
Phalanx amputation was required for seven fingers (five limbs) and amputation above the wrist was required for two limbs.
At 1 year, the rate of complete wound healing was 19% among the 26 surviving patients.
Overall, 56% of patients died during follow-up. “In the present study, cardiovascular and infectious diseases were the chief causes, similar to the mortality data from patients with PAD and [critical limb ischemia],” the researchers wrote.
The primary outcome of amputation-free survival at 1 year was 56.4%. Overall survival at 1 year was 59.4%.
In other results, the rate of limb salvage was 93.1% and freedom from major adverse limb events, including major amputation or any repeat revascularization of the limb, was 78.5%.
Diabetes (P = .03), hemodialysis (P < .001), PAD (P = .003) and presence of a wound (P < .001) were identified as predictors of amputation-free survival at 1 year, according to univariate analysis.
“Endovascular therapy for upper-limb PAD with [critical hand ischemia] may have an important role as an alternative first-line therapy to alleviate hand symptoms and avoid major amputation, though complete wound healing may be infrequent because of a short life expectancy,” the researchers wrote. “... Further investigations are needed to improve the outcomes of [critical hand ischemia patients.”
Disclosure: The researchers report no relevant financial disclosures.
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